Dry Eye or Dry Eye Syndrome (DES) is the leading cause of ocular irritation in the United States and is estimated to afflict well over 25 million Americans nationwide with an increased prevalence to 1 in 4 Americans over 60.
The comfort and vision of the human eye depends greatly on the flow, composition, regular spreading, and proper drainage of the tears. When this system is functioning properly the tears provide consistent moisture, lubrication, and protection for the ocular surface. The tears themselves are a mixture of water (secreted by the lacrimal gland for moisture), mucus (for lubrication), and an oil component (secreted by meibomian glands of the lids for even spreading and decreased tear evaporation), as well as antibodies and special proteins for resistance to infection. Tears are spread over the eye every 8-10 seconds by normal blinking and drained by the tear ducts into the nose. Each component of the tears is produced by specific glands or cells in a specific amount and when an imbalance occurs, a person may experience the symptoms of dry eyes.
Symptoms of Dry Eye Consist of:
• Sandy, gritty, or foreign body sensation
• Light sensitivity
• Blurring of vision
• Excessive tearing
In addition to an imbalance in tear components, there are many environmental situations, medications, and systemic conditions that can contribute, such as:
• The natural aging process, especially menopausal changes
• Contact lens wear; soft or hard lenses
• Allergies can often worsen dry eye symptoms
• Smoke, dry or dusty environments, air conditioning/heat, or wind
• Excessive computer use
• Many medications including birth control, antihistamines, ACE inhibitors, and hormone replacement therapy
• Sjogren’s syndrome, rheumatoid arthritis, rosacea as well as other common autoimmune and collagen vascular diseases
Types of Dry Eye
The hallmark of dry eyes is inflammation. When the tear components are not made it the correct quantities or quality, the front surface of the eye, particularly the cornea and conjunctiva get inflamed and this leads to the signs and symptoms often noted by patients and doctors. Although inflammation is the underlying cause, dry eye usually falls into two main categories with different treatments.
Aqueous (water) Deficiency Dry Eye occurs when the lacrimal gland no longer produces enough of the watery layer to wet the eye. As the eye dries, the front surface of the cornea develops irritated areas as shown below which leads to the sandy gritty feeling often noted by patients with this dry eye type. This type is more common with age, menopausal changes, and after LASIK surgery.
The second type of dry eye is Evaporative Dry Eye which occurs when there is a sufficient watery component in the eye; however, there is not enough oil to keep the tears stable and there is excessive evaporation. Often times this variant of dry eye occurs with either inflammation and blockage of the meibomian (oil secreting) glands on the lid termed meibomitis (pictured below) or a generalized inflammation, redness, and crusting of the entire lid margin itself termed blepharitis. These two conditions are caused by the natural bacteria in the tears irritating the tissues of the lids and causing decreased oil production and inflammation of the eye surface. Since the tears are evaporating even though there is enough of the liquid component, this dry eye often leads to excessive watering called reflex tearing.
Treatment for Dry Eye
Treatment for dry eyes is a tailored process that seeks to reestablish the proper balance of tear composition by identifying the defective tear component and treating accordingly. As a result, dry eye treatment is usually quite different patient to patient. The treatment for dry eyes often includes artificial tears, prescription eye drops, oral supplements, oral prescription medications, and simple in office procedures like punctal plugs.
While the treatment for Dry Eye Syndrome often varies depending on the cause of the dryness, there are many lifestyle and environmental changes that benefit all types of dry eye.
• Avoid smoke when possible
• Increase water consumption to improve lacrimal gland production
• Avoid diuretics like excessive caffeine and alcohol as well as artificial sweeteners
• Employ humidifiers around the house especially in bedrooms and living rooms
• Proper care of contact lenses including no overnight wear and appropriate lens replacement
• Place computer monitors and televisions below line of site to allow easier and more regular blinking
• Take frequent breaks from computer usage which has been show to decrease the natural blink rate to every 25-30 seconds!
If you suffer from dry eyes, you are not alone, please allow us to improve your comfort and quality of life by calling and scheduling a Dry Eye Evaluation today!